Pre-pregnancy GLP-1 use shows no clear harm signal, and early surgical menopause carries a vascular cost

The edition in brief

Ten observational studies covering about 2.1 million women, of whom 8,325 were exposed to GLP-1 receptor agonists around conception, found no clearly detectable rise in miscarriage, congenital anomalies, preterm birth, hypertensive disorders or gestational diabetes. The authors state that this does not establish safety because of confounding and thin data. A network meta-analysis of eight randomised trials (4,078 high-risk women) linked higher-dose vitamin D to lower preeclampsia risk, but with low certainty from sparse networks, and the authors call it hypothesis-generating. A Canadian guideline on alcohol and pregnancy emphasises validated screening, brief intervention and fast referral. A meta-analysis of 36 studies found that iatrogenic menopause was associated with more cardiovascular events and stroke, with excess mortality confined to menopause before age 45.